State stance on more Medicaid for the poor unlikely to shift

Republican lawmakers in North Carolina are standing by their controversial decision last year to deny Medicaid expansion to 500,000 low-income people who otherwise lacked health coverage.

Some Democrats in the General Assembly are pushing to revisit Medicaid expansion, however. The legislative season had barely gotten underway last week when a group of Democratic lawmakers introduced a bill that would reverse course on Medicaid expansion.

The federal Medicaid expansion last year was aimed at millions of poor Americans without health insurance who didn’t qualify for Medicaid under the old criteria.

Statewide, about 500,000 people who lacked health coverage would have become eligible for Medicaid under the expansion.

North Carolina turned down Medicaid expansion, however — along with the federal government’s offer to pay the full cost of that expansion for three years, with states expected to pick up 10 percent of the cost after that.

North Carolina was one of about 20 states to decline Medicaid expansion.

N.C. Rep. Joe Sam Queen, D-Waynesville, said turning down Medicaid expansion made no sense. It’s a common refrain for Queen when on the political stump.

Expanding Medicaid would have saved lives among those who need care but can’t afford it, Queen said, citing a study by the N.C. Institute of Medicine. It would have created jobs due to additional healthcare services being provided and would have relieved the burden on hospitals who are left holding the bag when low-income, uninsured patients can’t pay their bills, Queen says.

Plus, it’s free money from the feds for three years.

“Anybody who knows about economics is in favor of it,” Queen said. “This is money we have paid, through our taxes, into the federal treasury that would come back to this state. Right now, we are collecting the taxes and giving it to other states.”

But just because the federal government would foot the tab doesn’t make it right, according to Republican lawmakers. Tax money is tax money, and spending federal dollars on new programs is the wrong move if the money isn’t there — and judging by the federal deficit, the money isn’t there.

“Nothing is a good deal if you can’t pay for it,” said Sen. Jim Davis, R-Franklin.

Republican lawmakers who turned down Medicaid expansion were also leery of a bait-and-switch, fearing the federal government might recant on covering the lion’s share of new Medicaid costs as promised.

Estimates suggest the half million people who would have been added to Medicaid rolls in North Carolina would carry a price tag of $2 billion. While the federal government pays that bill for the first three years, the state picks up 10 percent of the cost after that point — and 10 percent of $2 billion is still a hefty load. Plus, Davis contends, Medicaid is already a drain on state coffers.

“It is driving the state budget,” Davis said. “Medicaid is out of control. We are not the only state wrestling with that problem. We have to address that.”

When heading back to Raleigh last week, Republican lawmakers were less interested in dredging up the debate over Medicaid expansion, and instead hoped to tackle Medicaid reform during this year’s legislative session.

Medicaid is an irksome wild card in the state budget — it simply costs what it costs, with little predictability of how many people will be on the rolls from year to year or what kind of health care they will seek. Medicaid costs grow year over year, to the chagrin of state lawmakers.

But there is some room to whittle at Medicaid costs, Davis said.

The state currently offers a more generous package of benefits to Medicaid recipients than it is required to. The state could reel in some of the optional services being covered and require bigger copays from Medicaid patients — which Republican lawmakers hoped to do under Medicaid reform this year.

But tweaking Medicaid benefits requires federal permission, a process that could take years “lost in bureaucratic morass,” Davis said.

Medicaid reform went from being at the top of Republican’s legislative agenda this year to second-tier status, behind the $400 million state budget shortfall and a teacher salary overhaul, which was costing lawmakers even more points in the opinion polls than the move to deny Medicaid expansion.

Meanwhile, it is unlikely that Democrats’ bill to expand Medicaid will get any traction either, despite Queen calling it a top priority for the 2014 legislative session.

“It is the single most important thing we could do to help the economy this session,” Queen said, citing 400 jobs in healthcare that would have been supported by Medicaid expansion in Haywood, Jackson and Swain to serve the roughly 20,000 working poor that would have been added to Medicaid rolls in those three counties.

Despite taking political heat last year for denying Medicaid expansion, Republican lawmakers haven’t warmed to the idea over the winter break. And since they remain in the majority, the Democrats’ bill appears dead on arrival in Raleigh.

But if nothing else, the renewed posturing by Democrats to expand Medicaid could provide campaign fodder this fall.

Jane Hipps, D-Waynesville, who is running against Davis, has already perfected her lines on Republican failings to expand Medicaid.

“We didn’t look out for our state when that money was thrown away. By not expanding Medicaid we are putting a burden on our hospitals, so we are paying for it twice,” Hipps said.

Medicaid expansion: a party line affair

The vote denying Medicaid expansion to 500,000 working poor in North Carolina last year was along party lines, with just one of the 170 state legislators in the House and Senate voting against the party’s position. Here’s how WNC legislators voted on a Medicaid expansion: